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PROVIDENCE PEDIATRIC PRACTICE LLC
NPI 1932160629
Pediatrics in Media, PA

Active since March 31, 2006CLIA 39D0930835 · Waiver
100 GRANITE DR, SUITE 200, MEDIA, PA 19063(610) 565-1945(610) 892-7848 Get Directions Write a Review

NPPES record last updated: March 18, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Providence Pediatric Practice Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE PEDIATRIC PRACTICE LLC (NPI 1932160629) is a healthcare organization registered as a pediatrics in Media, Pennsylvania and active in the NPI registry since March 2006. The organization holds a CLIA Waiver certificate valid through July 17, 2027 and lists Jacquelyn H Gibbons, Physician Senior Partner, as its authorized official.

NPPES Registry Identity

NPI1932160629
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NamePROVIDENCE PEDIATRIC PRACTICE LLC
Location Address100 GRANITE DR, SUITE 200Media, PA 19063-5134
Mailing Address100 Granite Dr, Suite 200Media, PA 19063-5134 · (610) 565-1945 · Fax (610) 892-7848
Phone(610) 565-1945
Fax(610) 892-7848
Organization SubpartNo
Authorized OfficialJacquelyn H GibbonsPhysician Senior Partner · (610) 565-1945
Enumeration DateMarch 31, 2006
Last NPPES UpdateMarch 18, 2009
✔ NPI 1932160629 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
100 GRANITE DR, Media, PA 19063
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Highmark Blue Cross Blue Shield Delaware.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D0930835

Providence Pediatric Practice, LLC · Media, PA
Active · expires Jul 17, 2027
CLIA Number39D0930835
Laboratory TypePhysician Office
Certificate Effective DateJuly 18, 2025
Certificate Expiration DateJuly 17, 2027
Laboratory DirectorDr. Allison R. Horowitz
Laboratory Phone(610) 892-8957
Laboratory LocationProvidence Pediatric Practice, LLC100 Granite Drive,suite 200, Media, PA 19063
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. WILLIAM JOSEPH STROWHOUER DO
Family Medicine
100 GRANITE DR, SUITE 207
MEDIA, PA 19063
Delaware County (610) 566-8885
DR. ALISON GAUDET M.D.
Pediatrics
100 GRANITE DR, SUITE 200
MEDIA, PA 19063
Delaware County (610) 565-1945
MS. OLIVIA THERESA DIMAGGIO MD
Pediatrics
100 GRANITE DR, STE 200
MEDIA, PA 19063
Delaware County (610) 565-1945
ALLISON R HOROWITZ M.D.
Pediatrics
100 GRANITE DR, SUITE 200
MEDIA, PA 19063
Delaware County (610) 565-1945
RIDDLE DIALYSIS LLC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
100 GRANITE DR, STE 106
MEDIA, PA 19063
Delaware County (610) 892-4701
MRS. BETSY G RACE MD
Pediatrics
100 GRANITE DR, SUITE 200
MEDIA, PA 19063
Delaware County (610) 565-1945

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Pediatric Practice LLC's NPI number?

The NPI number for Providence Pediatric Practice LLC is 1932160629. It was assigned to this organization in the NPPES registry on March 31, 2006.

Where is Providence Pediatric Practice LLC located?

Providence Pediatric Practice LLC is located at 100 Granite Dr Suite 200, Media, PA 19063. The listed phone number is (610) 565-1945.

What is Providence Pediatric Practice LLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Providence Pediatric Practice LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D0930835) is associated with this NPI, valid through July 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Providence Pediatric Practice LLC accept?

Health plans from Highmark Blue Cross Blue Shield Delaware list Providence Pediatric Practice LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Providence Pediatric Practice LLC was last updated on March 18, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.